EP3565486B1

EP3565486B1 - Osteotome with a distal portion for simultaneous advancement and articulation

Info

Publication number: EP3565486B1
Application number: EP18736547.3A
Authority: EP
Inventors: Craig Purdy; Dan Balbierz
Original assignee: Dfine Inc
Current assignee: Dfine Inc
Priority date: 2017-01-06
Filing date: 2018-01-04
Publication date: 2021-11-10
Anticipated expiration: 2038-01-04
Also published as: US20200390449A1; US11607230B2; WO2018129180A1; US10660656B2; EP3565486A1; US20180193036A1; EP3565486A4

Description

TECHNICAL FIELD

The present disclosure relates generally to the field of medical devices. More particularly, some embodiments relate to osteotomes that are configured for simultaneous advancement and articulation of a distal portion of the osteotome. Related methods and systems are also disclosed.
The invention provides a medical device according to claim 1.

BRIEF DESCRIPTION OF THE DRAWINGS

The written disclosure herein describes illustrative embodiments that are non-limiting and non-exhaustive. Reference is made to certain of such illustrative embodiments that are depicted in the figures, in which:

FIG. 1 is a perspective view of an osteotome.
FIG. 2 is an alternative perspective view of the osteotome of FIG. 1.
FIG. 3 is a cross-sectional view of the osteotome of FIG. 1 through plane 3-3 of FIG. 1.
FIG. 4 is a cross-sectional perspective view of the osteotome of FIG. 1 through plane 4-4 of FIG. 1.
FIG. 5 is an exploded perspective view of the osteotome of FIG. 1.
FIG. 6 is a perspective view of a distal portion of the osteotome of FIG. 1 in a fully retracted and straight configuration.
FIG. 7 is a bottom view of the distal portion of the osteotome of FIG. 1 in a fully retracted and straight configuration.
FIG. 8 is a cross-sectional side view of the distal portion of the osteotome of FIG. 1 in a fully retracted and straight configuration.
FIG. 9 is a cross-sectional side view of a distal portion of the osteotome of FIG. 1 in a fully advanced and articulated configuration.
FIG. 10A is a cross-sectional view of the osteotome of FIG. 1 in a first configuration.
FIG. 10B depicts the osteotome of FIG. 1 in a vertebra of the patient when the osteotome is in the first configuration.
FIG. 11A is a cross-sectional view of the osteotome of FIG. 1 in a second configuration.
FIG. 11B depicts the osteotome of FIG. 1 in a vertebra of the patient when the osteotome is in the second configuration.
FIG. 12A is a cross-sectional view of the osteotome of FIG. 1 in a third configuration.
FIG. 12B depicts the osteotome of FIG. 1 in a vertebra of the patient when the osteotome is in the third configuration.

DETAILED DESCRIPTION

An osteotome may be used to create or expand a cavity within bone of a patient. For example, a distal portion of an osteotome may be inserted into a bone (e.g., a vertebra) of the patient. Once the distal portion of the osteotome is disposed within the bone of the patient, the distal portion of the osteotome may be displaced. Such displacement may cut, grind, granulate, fragmentize, deform, displace, or otherwise alter the bone, thereby creating and/or expanding a cavity within the bone. Document US 2016/331443 A1 discloses such an osteotome with some steering means comprising means for converting translating an inner shaft relative to an outer shaft, so that the translation of the inner shaft forces the tip to bend.
As the distal portion of the osteotome is displaced, the bone of the patient may exert one or more forces on the distal portion of the osteotome. For example, where the distal portion of the osteotome is transitioned from a linear configuration to a bent configuration without simultaneous advancement of the distal portion of the osteotome in a distal direction, the distal portion of the osteotome may contact bone that exerts one or more reactionary forces on the distal portion. Such force(s) may damage or weaken the osteotome.
In embodiments described herein, the osteotome may be manipulated such that a distal portion of the osteotome is simultaneously advanced and articulated. For example, in some embodiments, rotation of a handle may cause the distal portion of the osteotome to simultaneously both (1) be advanced within the bone of the patient and (2) bend away from a longitudinal axis of the osteotome. Relative to other methods, the simultaneous advancement and articulation of a distal portion of an osteotome may reduce the magnitude of one or more forces that may act on the distal portion of the osteotome. Stated differently, simultaneous advancement and articulation of the distal portion may reduce one or more forces on the distal portion of the osteotome relative to other methods in which advancement and articulation are separated in time, thereby decreasing the risk of breakage or other damage to the osteotome.
The components of the embodiments as generally described and illustrated in the figures herein can be arranged and designed in a wide variety of different configurations. Thus, the following more detailed description of various embodiments, as represented in the figures, is not intended to limit the scope of the present disclosure, but is merely representative of various embodiments. While various aspects of the embodiments are presented in drawings, the drawings are not necessarily drawn to scale unless specifically indicated.
The phrase "coupled to" is broad enough to refer to any suitable coupling or other form of interaction between two or more entities. Two components may be coupled to each other even though they are not in direct contact with each other. For example, two components may be coupled to each other through an intermediate component. Two components are "fixedly coupled" to each other if neither component is displaceable relative to the other. The phrase "attached to" refers to interaction between two or more entities which are in direct contact with each other and/or are separated from each other only by a fastener of any suitable variety (e.g., an adhesive).
The terms "proximal" and "distal" are opposite directional terms. For example, the distal end of a device or component is the end of the component that is furthest from the practitioner during ordinary use. The proximal end refers to the opposite end, or the end nearest the practitioner during ordinary use.
FIGS. 1-5 provide various views of a medical device 100 (an osteotome) or portions thereof for creating or expanding a cavity within a bone of a patient. For example, FIG. 1 provides a first perspective view of the medical device 100. FIG. 2 provides a second perspective view of the medical device 100. FIG. 3 provides a first cross-sectional view of the medical device 100 through plane 3-3 of FIG. 1. FIG. 4 provides a cross-sectional perspective view of the medical device 100 through plane 4-4 of FIG. 1. FIG. 5 provides an exploded perspective view of the medical device 100. FIGS. 6-8 provide perspective (FIG. 6), bottom (FIG. 7), and cross-sectional (FIG. 8) views of a distal portion 108 of the medical device 100 in a fully retracted and straight configuration. FIG. 9 provides a side view of the distal portion 108 of the medical device 100 in a fully advanced and articulated configuration. Elements of the medical device 100 are also shown in FIGS. 10A-12B.
As shown in FIGS. 1-12B, the medical device 100 may include, among other elements, a handle 102, a housing 110, a first shaft 120, a second shaft 130, a third shaft 140, a fourth shaft 150, a shuttle 160, and a casing 170.
The handle 102 may be coupled to the first shaft 120 such that rotation of the handle 102 results in rotation of the first shaft 120. In some embodiments, the handle 102 is coupled to the first shaft 120 such that when the handle 102 is rotated, the first shaft 120 rotates at the same rate as the handle 102. Stated differently, as the handle 102 is rotated 360 degrees about a longitudinal axis (l), the first shaft 120 may also rotate 360 degrees about the longitudinal axis (l).
In the depicted embodiment, the handle 102 is coupled to the first shaft 120 by inserting a hexagonal proximal portion 123 of the first shaft 120 into a complementary hexagonal opening 106 on the handle 102. A fastener 104 (e.g., a bolt) may then be inserted through the handle 102 into a proximal opening 121 of the first shaft 120 such that the fastener 104 is threadably engaged with interior threads 129 disposed adjacent to a proximal end of the first shaft 120. In some embodiments, a washer 103 is disposed between the fastener 104 and the handle 102.
The housing 110 may be generally elongate in shape. In the depicted embodiment, the housing 110 includes interior threads 112 disposed adjacent the proximal end of the housing 110, a recess 116, a distal adaptor 107, proximal exterior threads 114, and distal exterior threads 115. The distal adaptor 107 (e.g., a male luer connection) may be configured to facilitate attachment to an introducer that has been inserted into a patient. The housing may encompass or partially encompass various components, such as the shuttle 160, the casing 170, and the second shaft 130.
In some embodiments, the housing 110 is formed from two separate portions (see FIG. 5) that are attached to one another. For example, in some embodiments, the medical device 100 includes one or more threaded caps 192, 194 that secure a first portion of the housing 110 to a second portion of the housing 110. A proximal threaded cap 192 may be configured to threadably engage with the proximal exterior threads 114, while a distal threaded cap 194 may be configured to threadably engage with the distal exterior threads 115 of the housing 110. The interaction between the threaded caps 192, 194 and the exterior threads 114, 115 of the housing 110 may secure a first portion of the housing 110 to the second portion of the housing 110.
The first shaft 120 includes exterior threads 124. The exterior threads 124 theadably engage with the interior threads 112 of the housing 110 such that the first shaft 120 is threadably coupled to the housing 110. Due to the threaded interaction between the first shaft 120 and the housing 110, rotation of the handle 102 in a first (e.g., clockwise) direction causes simultaneous rotation of the first shaft 120, thereby distally displacing the first shaft 120 with respect to the housing 110. As discussed below, the exterior threads 124 have a pitch that is greater than the pitch of exterior threads 132 on the second shaft 130. In some embodiments, the exterior threads 124 of the first shaft 120 form a right-handed helix.
The first shaft 120 may be coupled to the shuttle 160 that is disposed within the housing 110. For example, the shuttle 160 may be rotatably (but not threadedly) coupled to the first shaft 120 such that rotation of the first shaft 120 in a first (e.g., clockwise) direction with respect to the housing 110 results in axial displacement of the shuttle 160 relative to the housing 110. More particularly, an inward-projecting ridge 166 adjacent the proximal end of the shuttle 160 may be disposed within an exterior slot 127 of the first shaft 120 such that axial displacement of the first shaft 120 results in an equal magnitude of axial displacement of the shuttle 160. In some embodiments, the shuttle 160 is formed from two separate components (e.g., halves) that are attached to one another, such as via screws 111.
The shuttle 160 may further include an aperture 162. The aperture 162 may be configured to permit extension of an arm of the casing 170 through the shuttle 160 for interaction with a recess 116 of the housing 110 as described in further detail below. The shuttle 160 may also include one or more recesses 164 that are designed to accommodate (e.g., secure) an anchor 142 at the proximal end of the third shaft 140. The shuttle 160 may be configured to travel back and forth within the housing 110 along the longitudinal axis of the medical device 100.
In some embodiments, the first shaft 120 further includes an inner sleeve 126 disposed adjacent to the distal end of the first shaft 120. The inner sleeve 126 may be coupled to the remainder of the first shaft 120 such that the inner sleeve 126 and the first shaft 120 rotate at the same rate. In other words, the inner sleeve 126 may be fixedly coupled to a remainder of the first shaft 120. The inner sleeve 126 may have a composition that differs from the composition of the remainder of the first shaft 120. For example, in some embodiments, the inner sleeve 126 is formed from a metal or metal alloy, while the remainder of the first shaft 120 is formed from a synthetic polymer (e.g., a plastic). The composition of the inner sleeve 126 may provide increased durability relative to the composition of the remainder of the first shaft 120. In other embodiments, there is no separate inner sleeve 126.
The first shaft 120 further includes interior threads 122 that are disposed adjacent the distal end of the first shaft 120. In the depicted embodiment, the interior threads 122 are disposed on an interior of the inner sleeve 126.
The second shaft 130 is threadably coupled to the first shaft 120. For example, in the depicted embodiment, the interior threads 122 adjacent the distal end of the first shaft 120 may threadably engage with the exterior threads 132 of the second shaft 130. The interior threads 122 of the first shaft 120 and the exterior threads 132 of the second shaft 130 may each have a shorter pitch than the exterior threads 124 of the first shaft 120 and the interior threads 112 of the housing 110. In some embodiments, the exterior threads 132 of the second shaft 130 form a right-handed helix.
As the first shaft 120 is rotated in a first (e.g., clockwise) direction, the second shaft 130 is prevented from rotating about the longitudinal axis (l) of the medical device by the casing 170 described in greater detail below. Thus, rotation of the first shaft 120 in a first direction causes the first shaft 120 to move distally with respect to the second shaft 130 due to the difference in pitch between the threads 122, 132, and the threads 124, 112. Thus, rotation of the first shaft 120 with respect to the housing 110 may result in axial displacement of the casing 170 relative to the shuttle 160.
As shown in FIG. 5, in some embodiments, the casing 170 is generally T-shaped. The casing 170 may be formed from two separate components (e.g., halves) that are attached to one another. In some embodiments, a proximal portion of the casing 170 is fixedly coupled to the second shaft 130 (e.g., via an adhesive). A distal portion of the casing 170 may be coupled to a proximal end of the fourth shaft 150. For example, the casing 170 may be formed by attaching a first half of the casing 170 that includes a hemisphere-shaped indentation with a second half of the casing 170 that includes another hemisphere-shaped indentation. The indentations on each half of the casing 170 may cooperate to form a pocket (e.g., a spherical pocket) that accommodates a bulbous proximal end 152 (e.g., a spherical ball) of the fourth shaft 150. Due to this interaction, the proximal end 152 of the fourth shaft 150 may be axially displaced with the casing 170 as described in greater detail below. Stated differently, the proximal end 152 of the fourth shaft 150 may move with the casing 170 along the longitudinal axis (l) of the medical device 100.
The casing 170 may include one or more arms that are configured to interact with one or more recesses 116 within the housing 110. For example, in some embodiments, each arm of the T-shaped casing 170 may extend though an aperture 162 in the shuttle 160 to the recess 116 within the housing 110. The recess(es) 116 of the housing 110 may interact with the casing 170 to prevent rotation of both the casing 170 and the second shaft 130 relative to the housing 110.
The third shaft 140 may be a metallic shaft that extends from a proximal anchor 142 that is disposed (e.g., secured) within the recess(es) 164 of the shuttle 160 to a position at or adjacent to the distal end of the medical device 100. The third shaft 140 may include an elongate lumen that extends from a proximal opening in the anchor 142 to adjacent the distal end of the medical device 100. In some embodiments, the third shaft 140 may include a plurality of slots 144 (see FIGS. 6-9) adjacent its distal end.
The fourth shaft 150 may be a metallic shaft that extends distally from the bulbous proximal end 152 within the casing 170 to a position at or adjacent to the distal end of the medical device 100. In some embodiments, the fourth shaft 150 includes an elongate lumen. Like the third shaft 140, the fourth shaft 150 may include a plurality of slots 154 adjacent its distal end. In some embodiments, the slots 154 may be disposed opposite the slots 144 of the third shaft 140.
The fourth shaft 150 may be at least partially disposed within an elongate lumen of the third shaft 140. Stated differently, the third shaft 140 may be disposed around a distal portion of the fourth shaft 150.
The third shaft 140 and the fourth shaft 150 may together form an articulating distal portion 108 of the medical device 100. As shown in FIGS. 8 and 9, the fourth shaft 150 may be attached (e.g., welded) to the third shaft 140 at a position that is adjacent to a distal end of the third shaft 140 while the remainder of the fourth shaft 150 is unattached from the third shaft 140. In other words, a proximal portion of the fourth shaft 150 may be longitudinally displaceable relative to the third shaft 140. By displacing the proximal end of the fourth shaft 150 relative to the third shaft 140 as described in greater detail below, the articulating distal portion 108 of the medical device 100 may be displaced. More specifically, by displacing the proximal end of the fourth shaft 150 relative to the third shaft 140, the distal portion of the medical device 100 may transition from a linear configuration (FIGS. 6-8) to a non-linear configuration (FIG. 9) and vice versa.
The medical device 100 may be used in one or more medical procedures, such as procedures for creating or expanding a cavity within bone of a patient. Various stages of an exemplary procedure for creating or expanding a cavity within bone of a patient are shown in FIGS. 10A-12B. More particularly, FIG. 10A discloses a cross-sectional view of the medical device 100 in a first configuration. FIG. 10B shows the medical device 100 in the first configuration where the medical device 100 is at least partially disposed within an introducer 5. FIGS. 11A and 11B are analogous to FIGS. 10A and 10B, except that the medical device 100 is in a second configuration. FIGS. 12A and 12B similarly show the medical device 100 in a third configuration.
An exemplary medical procedure may involve obtaining a medical device, such as the medical device 100 (e.g., an osteotome) and inserting a distal region (e.g., a pointed distal tip) of the medical device 100 into bone of a patient. For instance, in some embodiments, a distal region of the medical device 100 is inserted through an introducer 5 into a vertebral body (see FIG. 10B) of a patient (e.g., a sedated human patient in the prone position). In some embodiments, the housing 110 of the medical device 100 may be coupled (e.g., attached) to the introducer 5 via the distal adaptor 107 prior to rotating the handle 102 and/or the first shaft 120 of the medical device 100 relative to the housing 110.
Once the distal end of the medical device 100 is disposed within bone of the patient (e.g., as shown in FIG. 10B), the practitioner may rotate the handle 102 about the longitudinal axis (l) of the medical device 100 in a first (e.g., clockwise direction). Due to the interaction of the handle 102 with the first shaft 120, such manipulation of the handle 102 of the medical device 100 causes rotation of the first shaft 120 relative to the housing 110. Rotation of the first shaft 120 relative to the housing 110 causes the first shaft 120 to be displaced in a distal direction relative to the housing 110 due to the interaction of the exterior threads 124 of the first shaft 120 with the interior threads 112 adjacent the proximal end of the housing 110.
Due to the interaction between the inward-projecting ridge 166 of the shuttle 160 and the exterior slot 127 of the first shaft 120, rotation of the first shaft 120 also causes the shuttle 160 to move distally with the first shaft 120 along the longitudinal axis (l) of the medical device 100. Stated differently, as a result of rotational input at the handle 102, the first shaft 120 and the shuttle 160 may move distally within the housing 110 at the same rate. In the depicted embodiment, the shuttle 160 does not rotate within the housing 110 about the longitudinal axis (I) of the medical device 100. Rather, because (1) the casing 170 does not rotate relative to the housing 110 due to the interaction between arms of the casing 170 and the recess 116 within the housing 110 and (2) rotation of the shuttle 160 is constrained by the casing 170, the shuttle 160 of the depicted embodiment cannot rotate about the longitudinal axis (l) of the medical device 100. Stated differently, rotation of the first shaft 120 relative to the housing 110 causes rotation of the inward-projecting ridge 166 within the exterior slot 127 of the first shaft 120.
Furthermore, as the proximal anchor 142 of the third shaft 140 is disposed within the recess 164 of the shuttle 160, the proximal portion of the third shaft 140 moves distally with both first shaft 120 and the housing 110. Stated differently, each of the first shaft 120, the shuttle 160, and the proximal portion third shaft 140 may move axially (e.g., distally) relative to the housing 110 at a first rate. In other words, the shuttle 160 and the third shaft 140 may be coupled to the first shaft 120 such that axial displacement of the first shaft 120 a first distance relative to the housing 110 results in axial displacement of the third shaft 140 and the shuttle 160 a distance relative to the housing 110 that is equal to the first distance.
Additionally, as the first shaft 120 is rotated relative to the housing 110, the interior threads 122 adjacent the distal end of the first shaft 120 interacts with the exterior threads 132 of the second shaft 130. More specifically, as the first shaft 120 is rotated relative to the housing 110, the first shaft 120 is distally displaced relative to the second shaft 130 due to the interaction between the interior threads 122 of the first shaft 120 and the exterior threads 132 of the second shaft 130. Like the shuttle 160, the second shaft 130 in the depicted embodiment does not rotate within the housing 110 about the longitudinal axis (l) of the medical device 100. Rather, the second shaft 130 is fixedly coupled to the casing 170 and is thereby rotationally constrained within the housing 110. Thus, as a result of being rotationally constrained in this manner, rotation of the first shaft 120 causes the second shaft 130 to move proximally relative to the first shaft 120. Further, as the pitch of the exterior threads 124 of the first shaft 120 and the interior threads 112 of the housing 110 is greater than the pitch of the interior threads 122 and the exterior threads 132, the first shaft 120 moves both (1) proximally relative to the shuttle 160 and (2) distally relative to the housing 110. Stated differently, as the handle 102 is rotated, the second shaft 130 moves distally within the housing 110 at a second rate that is different (e.g., slower) than the first rate at which the first shaft 120, the shuttle 160, and/or the proximal portion of the third shaft 140 move distally within the housing 110. In this manner, the fourth shaft 150 is coupled to the second shaft 130 such that axial displacement of the second shaft 130 a second distance relative to the housing 110 results in axial displacement of the fourth shaft 150 a distance relative to the housing 110 that is equal to the second distance.
As (1) the casing 170 is fixedly coupled to the second shaft 130 and (2) the fourth shaft 150 is coupled to the casing 170 due to the position of the bulbous proximal end 152 within the pockets of the casing 170, the casing 170 and the proximal portion of the fourth shaft 150 may move axially (e.g., distally) with the second shaft. Stated differently, the second shaft 130 and the fourth shaft 150 may move distally within the housing 110 at a second rate that is slower than the rate at which both the first shaft 120 and the proximal portion of the third shaft 140 move distally with respect to the housing 110.
As the proximal portion of the third shaft 140 moves distally with respect to the housing 110 at a rate that is greater than the rate at which the fourth shaft 150 moves distally with respect to the housing 110, a distal portion of the medical device 100 may transition from a linear configuration (FIGS. 6-8) to a non-linear configuration (FIG. 9).
For example, as the distance between the proximal anchor 142 of the third shaft 140 and the proximal bulbous end 152 of the fourth shaft 150 increases, the distal tip of the medical device 100 may be simultaneously displaced both (1) distally relative to the housing 110 and (2) laterally relative to the longitudinal axis of the medical device 100. Stated differently, as a result of rotation of the first shaft 120 relative to the housing 110, (1) the distal portion 108 of the medical device 100 may be articulated such that a distal tip of the medical device 100 is laterally displaced relative to a longitudinal axis (l) of the medical device 100 and (2) the distal portion 108 of the medical device 100 is displaced in an axial (e.g., distal) direction relative to the housing 110.
In the depicted embodiment, as the first shaft 120 is rotated relative to the housing 110, the distal portion 108 of the medical device 100 may transition from a linear configuration to a non-linear configuration such that (1) the slots 144 on the third shaft 140 are disposed on a concave side of a bend and (2) the slots 154 on the fourth shaft 150 are disposed on a convex side of the bend (see FIG. 9). From the perspective shown in FIGS. 10A, 11A, and 12A, the distal tip of the medical device 100 may be displaced away from the longitudinal axis and into the page. The transition from the linear configuration to the non-linear configuration may occur in a single plane. Stated differently, in some embodiments, movement of the distal portion 108 of the medical device 100 is limited to a single plane. By rotating the handle 102 and the first shaft 120 a selected amount, the articulating distal portion 108 may be bent to a selected degree.
In some embodiments, the process described above is reversible. Stated differently, the medical device 100 may transition from the non-linear configuration to the linear configuration by rotating the handle 102 and/or the first shaft 120 in a second direction (e.g., counterclockwise) that differs from the first direction.
Any methods disclosed herein include one or more steps or actions for performing the described method. The method steps and/or actions may be interchanged with one another. In other words, unless a specific order of steps or actions is required for proper operation of the embodiment, the order and/or use of specific steps and/or actions may be modified. Moreover, sub-routines or only a portion of a method described herein may be a separate method within the scope of this disclosure. Stated otherwise, some methods may include only a portion of the steps described in a more detailed method.
Reference throughout this specification to "an embodiment" or "the embodiment" means that a particular feature, structure, or characteristic described in connection with that embodiment is included in at least one embodiment. Thus, the quoted phrases, or variations thereof, as recited throughout this specification are not necessarily all referring to the same embodiment.
Similarly, it should be appreciated by one of skill in the art with the benefit of this disclosure that in the above description of embodiments, various features are sometimes grouped together in a single embodiment, figure, or description thereof for the purpose of streamlining the disclosure. This method of disclosure, however, is not to be interpreted as reflecting an intention that any claim requires more features than those expressly recited in that claim. Rather, as the following claims reflect, inventive aspects lie in a combination of fewer than all features of any single foregoing disclosed embodiment. Thus, the claims following this Detailed Description are hereby expressly incorporated into this Detailed Description, with each claim standing on its own as a separate embodiment. This disclosure includes all permutations of the independent claims with their dependent claims.
Recitation in the claims of the term "first" with respect to a feature or element does not necessarily imply the existence of a second or additional such feature or element. It will be apparent to those having skill in the art that changes may be made to the details of the above-described embodiments without departing from the underlying principles of the present disclosure.

Claims

A medical device (100) for creating or expanding a cavity within bone of a patient, the medical device comprising:
a housing (110);

a first shaft (120) that is threadably coupled to the housing, the first shaft comprising exterior threads (124) that threadably engage threads (112) of the housing;

a second shaft (130) that is threadably coupled to the first shaft, the second shaft comprising exterior threads (132) that threadably engage with interior threads (122) of the first shaft;

a third shaft (140) that is coupled to the first shaft such that a proximal portion of the third shaft moves axially with the first shaft; and

a fourth shaft (150) that is coupled to the second shaft (130) such that a proximal portion of the fourth shaft moves axially with the second shaft;

wherein a proximal portion of the fourth shaft is longitudinally displaceable relative to the third shaft;

wherein the fourth shaft is attached to the third shaft at a position that is adjacent a distal end of the third shaft;

wherein the exterior threads (124) of the first shaft have a pitch that is greater than a pitch of the exterior threads (132) of the second shaft; and

wherein the medical device is configured such that rotation of the first shaft relative to the housing in a first direction results in simultaneous displacement of a distal tip of the medical device in a distal direction relative to the housing and displacement of the distal tip of the medical device in a direction that is lateral to a longitudinal axis of the medical device.
The medical device of claim 1, wherein the medical device is configured such that rotation of the first shaft relative to the housing results in (1) axial displacement of the first shaft and the proximal portion of the third shaft relative to the housing at a first rate and (2) axial displacement of the second shaft and the fourth shaft relative to the housing at a second rate that is different from the first rate.
The medical device of claim 1 or claim 2, wherein the second shaft is coupled to the housing to prevent rotation of the second shaft relative to the housing.
The medical device of any one of claims 1-3, wherein:
the exterior threads of the first shaft form a right-handed helix; and

the exterior threads of the second shaft form a right-handed helix.
The medical device of any one of claims 1-4, wherein the fourth shaft is at least partially disposed within an elongate lumen of the third shaft.
The medical device of any one of claims 1-5, further comprising a handle (102) that is coupled to the first shaft such that rotation of the handle results in rotation of the first shaft.
The medical device of any one of claims 1-6, further comprising:
a casing (170) that is fixedly coupled to the second shaft and a proximal end of the third shaft; and

a shuttle (160) that is rotatably, but not threadably, coupled to the first shaft, wherein the shuttle is disposed within the housing;

wherein rotation of the first shaft with respect to the housing results in axial displacement of the casing relative to the shuttle.
The medical device of claim 7, wherein the housing comprises one or more recesses (116) that interact with the casing to prevent rotation of the second shaft relative to the housing.
The medical device of any one of claims 1-8, wherein the housing comprises an adaptor (107) that is configured to facilitate attachment of the housing to an introducer.